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APPLICATION FOR PERMIT <br /> ;. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZELTON AVE., STOCKTON, CA PERMIT <br /> Telephone (209) 466-6781 <br /> DATE ISSUED <br /> PERMIT EXPIRES 1 YEAR FROM :DATE ISSUED <br /> (Complete in Triplicate) <br /> ^'Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein <br /> described. ,This application is made in compliance with San Joaquin County Ordinance No. 549 for sewage or No. 1862 for well/pump <br /> and the Rules and Regulations of the, San JC1q6kboltJr&f&h41s r6c�_ School) . <br /> Job Address 1$950 N. Hwy. 99 Subdivision Name <br /> Owner's Name Goehrincj Meat Co. Address ' <br /> P.O .Box 147, Lodi Phone' <br /> Contractor's Name Goehring PL1ITlp License No. 309031 Phone <br /> TYPE OF WELL/PUMP WORK: NEW WELL WELL REPLACEMENT DESTRUCTION <br /> PUMP INSTALLATION SYSTEM REPAIR OTHER J <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER 1d ELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> J Industrial -'-- J-Open--Bottom- E]•Manteca- - 'Dia'.-of-Weld Excavation' -- -� <br /> Domestic/Private F-1 Gravel Pack ❑Tracy Dia, of Well Casing <br /> Public J Other- [] Delta T <br /> � ype of Casing <br />�. J Irrigation r 'Apprvx. E] Eastern <br /> Depth Specifications <br /> J Cathodic ProtectionCi, Depth of Grout Seal <br /> Geophysical �, +• <br /> 4 Type of Grout � <br /> J Others ?:.f f Surface Seal Installed by <br /> Repair Work Done J Type of Pump TLlrbJ Ile H'-P-., 20 State.Work-Done_- <br /> Well Destruction J Well Diameter , Sea-ling,Material (top 501 <br /> Depth 'Filler Material (Below 50') <br /> TYPE OF SEPTIC WORK:-;N EW�INSTALLATION [I REPAIR/ADDITIONJ (No septic tank or seepage pit permitted if public sewer is <br /> available within 200 feet.) <br /> f Installation will serve',r:Res.idence _ Commercial ,' Other <br /> v Number of living units: } •Number of bedrooms - -""^ L'ot size'" <br /> Character of soil to a depth of 3 feet: Water table depth <br /> SEPTIC TANK Type/Mfg -'Capacity No. Compartments <br /> PKG. TREATMENT PLT. Type/Mfg—­7 Capacity s Method of Disposal <br /> SEWAGE SYSTEM Distance-to-nearest:',,.We7,1 "Fo,und'ation :€ Property Line r� <br /> DESTRUCTION <br /> LEACHING LINE J 'No. & Length of lines Total length/size <br /> FILTER BED ❑ Distance to nearest: Well Foundation Property tine <br /> SEEPAGE PITS Depth Size Number <br /> 4 r SUMPS 1J Distance to nearest:~ We?1 Foundation' s °x Property Line <br /> DISPOSAL PONDS J �� <br /> f <br /> I hereby certify that I have prepared this application and that the work will ''be d6ne in accordance with San Joaquin county <br /> ordinances, state .laws, and rules and regulations of the San Joaquin Local Health District. <br /> Home owner or licensed agent's signature certifies the following: "I certify tliat 'in the performance of the work for which this <br /> permit is issued, I shall t employ any person in such manner as to become subject to workman t compensation laws of California." <br /> Contractor's hirin 0 contracting signature certifies the following: I certify that in the performance of the work for which <br /> this permit is i shat employ persons subject to workman's compensation-laws of California." <br /> The applicant f 1 required inspections. Complete drawing on reverse side. <br /> Signed XTitle: Bkpr. Date: 03/14/85 <br /> �DEPARTmENT USE ONLY <br /> Application Accepted by Area Stk 466-6781 <br /> Lodi 369-3621 <br /> Additional Comments: [ <br /> Pit or Grout Inspection by Date J Manteca 823-7104 <br /> Final Inspection by Date ❑ Tracy 835-6385 <br /> Applicant - Return all copies to: nvironmenta a th P rmit/Services 16 E. Hazelton Av P.O. Box 2009, Stk., CA 95201 <br /> FFEEBASE AMOUNT DUE AMOUNT REMITTED RECEIVED BY DATE PERMIT NO. <br /> f <br /> EH 13-24 REV. 10/82 10/82 500 <br /> 14-26 <br /> Fr <br /> � M1 <br />